5 Pulmonary Tuberculosis Nursing Care Plans

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Tuberculosis is an acute or chronic infection caused by Mycobacterium tuberculosis. TB is characterized by pulmonary infiltrates, formation of granulomas with caseation, fibrosis, and cavitation. People living in crowded and poorly ventilated conditions and who are immunocompromised are most likely to become infected. In the United States, incidence is higher among the homeless, drug-addicted, and impoverished populations, as well as among immigrants from or visitors to countries in which TB is endemic. In addition, persons at highest risk include those who may have been exposed to the bacillus in the past and those who are debilitated or have lowered immunity because of chronic conditions such as AIDS, cancer, advanced age, and malnutrition. When the immune system weakens, dormant TB organisms can reactivate and multiply.

When this latent infection develops into active disease, it is known as reactivation TB, which is often drug resistant. Multidrug-resistant tuberculosis (MDR-TB) is also on the rise, especially in large cities, in those previously treated with antitubercular drugs, or in those who failed to follow or complete a drug regimen. It can progress from diagnosis to death in as little as 4–6 weeks. MDR tuberculosis can be primary or secondary. Primary is caused by person-to-person transmission of a drug-resistant organism; secondary is usually the result of nonadherence to therapy or inappropriate treatment.

Nursing Care Plans

Here are five (5) nursing care plans (NCP) and nursing diagnosis (NDx) for pulmonary tuberculosis:

  1. Risk for Infection
  2. Ineffective Airway Clearance
  3. Risk for Impaired Gas Exchange
  4. Imbalanced Nutrition: Less Than Body Requirements
  5. Deficient Knowledge
  6. Other Possible Nursing Care Plans
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Ineffective Airway Clearance

Nursing Diagnosis

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May be related to

  • Thick, viscous, or bloody secretions
  • Fatigue, poor cough effort
  • Tracheal/pharyngeal edema

Possibly evidenced by

  • Abnormal respiratory rate, rhythm, depth
  • Abnormal breath sounds (rhonchi, wheezes), stridor
  • Dyspnea

Desired Outcomes

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  • Maintain patent airway.
  • Expectorate secretions without assistance.
  • Demonstrate behaviors to improve/maintain airway clearance.
  • Participate in treatment regimen, within the level of ability/situation.
  • Identify potential complications and initiate appropriate actions.
Nursing InterventionsRationale
Assess respiratory function noting breath sounds, rate, rhythm, and depth, and use of accessory muscles.Diminished breath sounds may reflect atelectasis. Rhonchi, wheezes indicate accumulation of secretions and inability to clear airways that may lead to use of accessory muscles and increased work of breathing
Note ability to expectorate mucus and cough effectively; document character, amount of sputum, presence of hemoptysis.Expectoration may be difficult when secretions are very thick as a result of infection and/or inadequate hydration. Blood-tinged or frankly bloody sputum results from tissue breakdown (cavitation) in the lungs or from bronchial ulceration and may require further evaluation or intervention.
Place patient in semi or high-Fowler’s position. Assist patient with coughing and deep-breathing exercises.Positioning helps maximize lung expansion and decreases respiratory effort. Maximal ventilation may open atelectatic areas and promote movement of secretions into larger airways for expectoration.
Clear secretions from mouth and trachea; suction as necessary.Prevents obstruction and aspiration. Suctioning may be necessary if patient is unable to expectorate secretions.
Maintain fluid intake of at least 2500 mL/day unless contraindicated.High fluid intake helps thin secretions, making them easier to expectorate.
Humidify inspired air and oxygenPrevents drying of mucous membranes and helps thin secretions.
Administer medications as indicated:
  • Mucolytic agents: acetylcysteine (Mucomyst);
Reduces the thickness and stickiness of pulmonary secretions to facilitate clearance.
  • Bronchodilators: oxtriphylline (Choledyl), theophylline (Theo-Dur);
Increases lumen size of the tracheobronchial tree, thus decreasing resistance to airflow and improving oxygen delivery.
  • Corticosteroids (prednisone).
May be useful in presence of extensive involvement with profound hypoxemia and when inflammatory response is life-threatening.
Be prepared for/assist with emergency intubation.Intubation may be necessary in rare cases of bronchogenic TB accompanied by laryngeal edema or acute pulmonary bleeding.
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See Also

Other recommended site resources for this nursing care plan:

Other nursing care plans related to respiratory system disorders:

Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student, he knows how frustrating it is to cram on difficult nursing topics. Finding help online is nearly impossible. His situation drove his passion for helping student nurses by creating content and lectures that are easy to digest. Knowing how valuable nurses are in delivering quality healthcare but limited in number, he wants to educate and inspire nursing students. As a nurse educator since 2010, his goal in Nurseslabs is to simplify the learning process, break down complicated topics, help motivate learners, and look for unique ways of assisting students in mastering core nursing concepts effectively.
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